Tears in fibrocartilage and soft tissue, especially peripheral meniscal tears, are relatively difficult to repair. Typically, a tear in the vascular region of the meniscus is sutured using arthroscopic techniques. The instrument may be inserted through small incisions which serve as anterior knee portals. Sutures on long needles are then passed through a meniscal repair instrument and through the meniscus. An incision is made in the back of the knee to permit the surgeon to pull the needles and suture out, and to tie the suture over the posterior joint capsule. This technique reapproximates the torn edges of the meniscus and allows for healing.
Although effective, this repair technique requires a surgeon skilled in arthroscopic meniscal repair. The technique is also relatively time consuming and more invasive than it need be, as it requires a second, posterior incision that increases the risk of infection and neurovascular damage. As a result, few surgeons will attempt meniscal repair, choosing instead to simply remove the damaged portion of the meniscus. The problem with this approach is that meniscal removal can cause increased stress on the articular cartilage, which may then lead to degenerative arthritis.
Surgical clips are often easier to insert than sutures. However, most clips are not biodegradable, and occasionally a second operation must be performed to remove the clip once the tissue has healed. Another disadvantage of these clips is that they are not well suited for meniscal and soft tissue repair, as they are typically metallic, relatively large, and may protrude from the tissue and cause joint irritation. Thus, although arthroscopic clips can be inserted through a single incision, they have typically not been used for repair of peripheral meniscal tears nor for arthroscopic repair of soft tissue.